Blood Transfusion Instructions

Blood Transfusion
Induction 2021
The following information provides a brief overview of local
Transfusion procedures at RCHT.
Please familiarise yourself with the patient information
leaflet: https://nhsbtdbe.blob.core.windows.net/umbraco-
assets-corp/14661/160511-27360-will-i-need-a-blood-
transfusion-final.pdf (this should be available in paper form
in all clinical areas)
This presentation has been compiled to give an overview
of the RCHT blood transfusion service as a remote
learning resource.
Please read all of the presentation.
There are assessment questions at the end, which must
be completed and returned to the Transfusion
Practitioners.
If further information is required, or you have any
questions, please contact the Transfusion Practitioners
(contact details included in presentation).

Site information
• Lab open 24/7 on Treliske site (link corridor)
Phone: 2500 09:00-17:30 / bleep: 3220 out of hours
• Blood Fridges (all with emergency O neg):
1. Issue fridge (main lab)
2. Tower Theatre reception (3rd floor)
3. Trelawney Theatre reception
4. Delivery Suite (also has neonatal O negs)
5. Remote hospitals: West Cornwall, St Michaels and Duchy
To activate the Major Haemorrhage
Protocol phone 2222
We don’t have “whole blood” as most patients don’t
Red Cells need a whole blood replacement so donations get

separated into components.
Main uses:
•Anaemia (mainly Haematology/Oncology patients)
•Trauma
•Surgery
Availability Times:
•Electronically matched blood from a valid Group and
Screen sample = 5 minutes. Not suitable for all
patients (e.g. if a patient has antibodies)
•ABO compatible blood can be available 15 minutes
after acceptance of a suitable sample
•For a new Group and Screen sample; crossmatching
will take 45 minutes manually or 1 hour electronically
RBCs are stored in the fridge(preferable)
Platelets
Stored at room temperature on a
moving agitator (because their job
in-vivo is to agglutinate and form a
clot!)
Mainly required by haematology/

oncology patients who have had
their bone marrow destroyed by
disease or chemotherapy.
Fresh Frozen Plasma and
Cryoprecipitate
Look very similar but the description on the pack is
different. Both products thawed when required
(approx. 20 minutes)
FFP – Used to replace clotting factors in

association with big bleeds and lots of red cell
replacement. Kept in fridge after thawing.
Cryo – usually only used in theatre and Critical

Care. Very concentrated FFP (rich in fibrinogen).
Kept at room temperature after thawing.
How much do we transfuse?
Haemostatic Packs for major
haemorrhage:
PACK A: 4 RBC and 4 FFP (only 4 RBC for
obstetrics as these ladies are
hypercoagulable)
PACK B: 4 RBC + 4 FFP + platelets (if on-site.

We don’t hold stock platelets so may need
blue light delivery)
PACK C: 4 RBC + 4 FFP + platelets + 2

CRYO (these packs will continue to be
produced until the lab is informed that the
patient has stopped bleeding or they are no
10,000 units per year but we also longer required. Platelets will depend upon
clinical indication)
waste in excess of £36k worth of
Unless use of ROTEM indicates otherwise
blood components per year (point of care testing used during big bleeds to
indicate the efficiency of the clotting system)
(this is all covered in more detail
Patient factors in the competency assessment)
PBM “patient blood management”

•Department of Health and Social Care initiative
•A multidisciplinary, evidence-based approach to optimising the care of patients who might need a blood transfusion
•PBM puts the patient at the heart of decisions made about blood transfusion to ensure they receive the best treatment and avoidable,
inappropriate use of blood and blood components is reduced
1.Consent for transfusion “Risks, alternatives, benefits” Verbal but must be recorded in the notes/ Prescribing
checklist completed by Dr in NerveCentre. Give a patient information leaflet
2.Rationale for transfusion “Don’t give two without review” Must be recorded in notes
Alternatives to donor blood
1. Iron – diet, oral and IV
2. Cell salvage (blood lost during surgery is collected, filtered,
washed and transfused back to the same patient)
Patients who refuse blood (including Jehovah’s

Witnesses) must have a Decision Document
recorded within their Medical Records AND in
the legal section of their notes
Positive Patient ID
The biggest risk of transfusion is clerical error. Ensure you perform all of your
patient identity checks by the bedside and avoid all distractions during the
checking process
Wrong blood in tube (WBIT) could result in a fatal transfusion of incompatible

blood.
Patients must verbally identify themselves by you asking them to state their
name and D.O.B wherever possible. The patient MUST be wearing a wrist band
which should be checked for full name, DOB and unique ID number.
*Never leave the patient’s bedside with an unlabelled tube*
Transfusion requests are NOT handled by MAXIMS but if required, ensure your
MAXIMS forms and labels for other samples are printed for BEFORE collecting
any blood samples.
Sample Taking
Complete request
form first
• Llama (the current electronic system)

should be used for labelling transfusion
samples
• If it is necessary to handwrite a sample,
an additional second sample may be
required (if no historic blood group on Labelling must be performed at the
record) bedside! Deliver urgent samples by
• Alterations or errors will be rejected. hand
(this is all covered in more detail in the sample taking competency assessment)
Collection and Tracking
• Blood tracking using barcode on staff ID badge (will be
activated after competency assessment)
• All units must be scanned out
• Blood must not be out of the fridge for more than 30 mins
after removal from a blood fridge (to reduce risk of
bacterial infection) unless it is being transfused
• Transfusions must be completed within 4 hours
of removal from the blood fridge
• Never lend your ID card to anyone
(this is all covered in more detail in the collection competency assessment)
Administration
• All checks must be made at the bedside
• Single checking (with the exception of paediatrics)
• No overnight transfusions (unless clinically urgent,
indication must be recorded in the notes)
• Average transfusion time (red cells) = 90 mins (faster in
emergencies, slower if at risk of overload e.g. cardiac
patients) / 30 mins for platelets, FFP and Cryo.
• Maximum time from removal from fridge to end of
transfusion= 4hours
• No pumps at RCHT for transfusion (except neonates)
Observations and reactions
1. What obs are required? Pulse, temperature, blood pressure,
respiration rate, O2 saturation
2. When are they required? Pre Transfusion baseline, 15
minutes after start of administration and end of transfusion
(minimum requirements)
3. What signs of a reaction might been seen? Rash, temperature
increase, rigors, vomiting, impending sense of doom, pain
(back, neck, loin), tachycardia, breathlessness.
If you are concerned that your patient might be having a

reaction: STOP THE TRANSFUSION, get help, inform Lab
What you need to do next -
• Complete the questions on the following slide to evidence that
you have viewed this Induction presentation
• Watch the online BloodTrack collection video (CITS portal)
https://www.youtube.com/watch?
v=qFNoO3dJfH8&feature=emb_logo
• Complete the relevant face to face competency assessments
with ward based assessors or Transfusion Practitioners within
3 months (Sample Taking, Collection, Administration,
Observation) assessments are available in the competency
pack on the clinical shelf of the intranet.
• Ongoing - attend clinical mandatory training every 2yrs
Transfusion Induction Questions.
Please email your answers to [email protected] and
include staff name, date of completion and job role. If the question is not
applicable to your role, please state n/a.
1. What is the current electronic labelling system used at RCHT?
2. What is the maximum amount of time a unit of blood can be out of
the cold chain before being returned to a fridge?
3. How do you contact the Transfusion Laboratory out of hours?
4. How many people perform the bedside checks pre administration?
5. Does this trust use pumps to administer transfusions?
6. What is the maximum time between removal from the fridge and
completion of a transfusion?
7. What is the biggest risk in Transfusion?
8. What initial action would you take if you thought that someone was
having a transfusion reaction?
Contact details
Blood Transfusion Lab: ext 2500
Transfusion Practitioners: (including llama enquiries)

ext 3093 / bleep 3046 / 07990 644572
Transfusion Admin: 07788 380535

[email protected]

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Blood Transfusion

Red Cells need a whole blood replacement so donations get

Mainly required by haematology/

FFP – Used to replace clotting factors in

Cryo – usually only used in theatre and Critical

PACK B: 4 RBC + 4 FFP + platelets (if on-site.

PACK C: 4 RBC + 4 FFP + platelets + 2

PBM “patient blood management”

Patients who refuse blood (including Jehovah’s

Wrong blood in tube (WBIT) could result in a fatal transfusion of incompatible

• Llama (the current electronic system)

If you are concerned that your patient might be having a

Transfusion Practitioners: (including llama enquiries)

Transfusion Admin: 07788 380535

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